Obesity

Obesity occupies the intersection where health and medicine meet. This intersection is far more important than it appears because of what it reveals about American culture and health potential. The trend and current position is skewed in the direction of medicine.

The American Medical Association proposes that obesity be classified as a disease. As such there might be more resources devoted to developing medications and surgical procedures to control or cure the disease and insurance coverage would be more available. In other words the medical enterprise is faced with addressing obesity and classifying it as a disease fits their operational model. It is difficult to argue that obesity is not a disease but it would be also difficult to imagine more resources devoted to controlling and reversing obesity. One conclusion is that medical care has not prevented, controlled or reversed obesity. Compare a group picture of Americans during the 1950s with one from today. The increase in body weight is striking.

Another view of obesity is that of a health condition that is a risk factor for multiple diseases. In that regard it is a danger to health status and it is of concern to the medical community. Successful resolution of obesity is a gateway to reducing a heavy health/medical burden on society. Notwithstanding the medical and surgical procedures necessary to treat the diseases secondary to obesity most evidence points to lifestyle factors resulting in obesity. Insufficient physical activity and poor diet are the main drivers for obesity. The primary aspects of poor diet are not eating enough plant based whole foods, eating too much highly processed food and drinking sweetened beverages. These are issues best addressed through individual motivation and community support. Relying upon medicine is counter productive. There are elements of the American culture also counter productive.   

Medication Nation

The War On Drugs has been ongoing for many years with little to show for it. The effort  consumed considerable public attention and resources and that does not count the private attention and resources devoted to the inappropriate and illegal use of drugs. The public arena is a particularly slow learner but enough time has passed that some things become obvious even if everyone will not accept them. The first is the War On Drugs failed with heavy human and financial cost. Second there is something about American society conducive to use of drugs. The illegal use of drugs is only part of the drug picture in America and it is not the largest part. Not to be ignored is the legal but inappropriate use of drugs, which is the largest part if not the majority of the drug picture.

America is conditioned to expect many and often unreasonable benefits from drugs. Pharmaceutical companies manufacture and use every means possible to sell drugs. Advertizing of drugs is unseemly and sometimes misleading. Physicians are trained and lobbied to prescribed drugs. Patients want relief from symptoms and complaints and they often expect it from drugs. We are a capitalistic society and there is no better example than drugs. Sometimes the market approach gets out of hand.

I'm Back

Hard to believe almost two years passed since the last entry on this blog. Whatever the reasons and excuses I'm bacccck. There continue to be plenty of issues in health and medicine worthy of comment and I will try to do some of them justice. Please note the distinction between health and medicine, which remains my belief, my philosophy and my theme.

Diseases Everywhere

When people want a diagnosis there is always one to give and eager medical enterprises to treat them. If medical care was that good and cures that assured, it would be a blessing. Otherwise.....

Prevention Of Harm To Oneself

Should people be prevented from doing harm to themselves? When that involves immediate and drastic harm the answer is yes. Suicide for example. When the harm is more gradual and less obviously acknowledged the response is more debatable. Smoking and junk food for example. Over time the linkage between cause and effect becomes more obvious and society chooses to act. Even then regulations are less effective than social norms. The wrinkle comes with the large commercial enterprises built upon bad habits. It is a long and arduous path to a healthy society and the future belongs to the children. When people make better choices, no one will sell the bad choices. If I'm not mistaken the sales of soda in the U.S. is declining. Most people want to look good and feel good and sooner or later they learn what it takes to accomplish that goal. In that regard a free market society is the best option. Business enterprises follow their customers or they go out of business. Just don't forget those children  

Medicaid

Georges Clemenceau said that war is too serious a matter to entrust to military men. There are, however, examples of military men who warned against war that politicians rushed to embrace. The same principle should be applied to health insurance, and Medicaid is a prime example. It could be a program to improve the health of the most vulnerable and sickest portion of our society or just another gold rush in a poorly conceived health system. A study from the University of Michigan reveals that the poorer health of surgery patients covered by Medicaid results in more complications, longer hospitalization and higher cost than patients with private insurance. I doubt that comes as a surprise to medical people, even surgeons. But, how urgent is the surgery? A wise surgeon once told me surgical skill is easier than knowing when to operate. Sad to say the hospitals will take the first step into the breech in order to brake their financial loses. Meanwhile, the medical community will continue to complain that medical decisions are taken out of their hands by administrators, bureaucrats and politicians.     

Granted the Medicaid population has more health problems and more serious health problems than the general population and certainly more than the population with private health insurance. During the early stages of expansion of Medicaid there will be financial strain. But what better population could there be to link health care with medical care to improve health status. Somewhere there needs to be a demonstration that the health care/medical care community can manage this problem. It is a more comprehensive approach than emergency rooms and surgical suites. I remember when during the early development of Family Medicine as a medical specialty they emphasized behavioral science. Maybe schools of public health should be a more active component in the struggle. Perhaps the University of Michigan will rise to the challenge now that they have highlighted the problem.      

Health Risk

People don't understand health risk. This leaves the door open for those who will to play politics and make money with the issue. Perhaps one day there might be foolproof diagnostic procedures, surgeries and drugs that will detect and treat disease without error or consequences at a low cost. But those days appear to be in the distant future. Meanwhile, secondary prevention as it currently exists is a loser both from a health and economic point of view. There is more than sufficient evidence to demonstrate the health and economic benefits of primary prevention starting with vaccinations and continuing with lifestyle including physical activity (exercise), nutrition, sleep and stress relief. The best thing the government could do for health is provide the opportunity for education, meaningful work and physical and economic security. In that regard, health insurance is as much, if not more, economic security than it is health security. Just as secondary prevention is not as beneficial as primary prevention, medical care is not as beneficial for optimum health status as health care.